In this chapter we will summarize some of the recent history of drug use, particularly psychoactive drug use, in our society, identify some of the current trends, and speculate on possible future trends and consequences. Any brief history is generally an oversimplification. If a history text discussed the Civil War in only a dozen pages, it would certainly oversimplify complex realities. That will also be true of any brief summary of the history of drug use, misuse and abuse. However, some general patterns are real and, even though there may be many individual and localized exceptions, there is a generally valid pattern. This will not be a summary of the whole history of drug use, but a summary of major trends of drug use in America, beginning with World War II; most of the emphasis on the 1960s and 1970s.

Charles "Lucky" Luciano

WORLD WAR II TO PRESENT

At the end of World War II, psychoactive drug use in America was essentially limited to the two major psychoactive drugs in our society—alcohol and tobacco. There was relatively little other use of psychoactive drugs because of limited availability. Marijuana use had always been common in the southwestern United States among the Mexican-American population and continues to be so. Marijuana use was also endemic among blacks in New Orleans and was traditionally associated with jazz musicians throughout the United States.

Narcotics usage had largely been eliminated because its availability had been dramatically decreased during the war, so that there were very few narcotics addicts in America at that point. Most of them, by necessity, had kicked the habit. Essen¬tially the only major types of narcotics users were those who were wealthy enough to get a doctor to prescribe it for them or persons who were themselves physicians or nurses and had access to morphine. As the war came to a close the American government became concerned about the increasing activity of communist groups in Italy and France, especially about their power among the labor unions. United States intelligence agents struck a deal with a man by the name of Lucky Luciano, a reputed American ganster. The deal was that Luciano would guarantee that there would be no strikes in Italy or in France; in return, he would be allowed to place shipments on boats to the United States that would pass through customs uninspected. The shipments, of course, were heroin. Luciano had arranged to stop the strikes through some rough tactics, typical of his associates in the mafia in Sicily and in the Corsican Unions. Thus a flourishing market for heroin was reestablished in the United States through the assistance of the U.S. Intelligence apparatus, a relationship that to some extent continued from that time until at least the recent past and maybe the present. Of course, after a while it was not that important to the United States that there were no strikes in Italy or France. The war was over, we were not worried about goods, so the deal broke down. Luciano and his friends had to start smuggling in contraband, but they had established a market in the United States, principally in New York City, where Luciano's own operations were; that market has been main¬tained and has grown from that day to the present. We thus had recreated a major drug problem in America. It had been here before and had greatly diminished during the war, but we had successfully reestablished it. In fact, it was now a bigger problem than it had been immediately before the war.

During this same time, within the licit drug area, researchers had begun developing drugs that seemed useful in the treatment of mental illness. We began to develop the major tranquilizers and the minor tranquilizers, and these drugs brought about a revolution in American psychiatry. There were state mental hospitals all over the United States full of people hospitalized for as long as 20 years—chronic, "backward" schizophrenics. They had come in and they had stayed. Through the use of drugs such as Thorazine(R) and Stelazine(R) and later Prolixin(R), most of these people were returned to the community. The numbers of patients in psychiatric hospitals were greatly reduced when we began large-scale usage of these psychoactive drugs. Having had such marvelous success with the severely mentally ill, coupled with substantial profits for the drug companies, the medical community and the pharmaceutical manufacturing community began imagining what might they do for the people who are borderline psychotic, neurotic, borderline neurotic, or just a little unhappy. As a result, there was a dramatic increase in the use of tranquilizers among the people who we typically thought of as being a relatively normal population.

More and more we found ordinary problems of living being redefined as psychiatric problems in need of medication. One of the classic advertisements in medical journals showed a teenage boy with a bad case of acne; the caption read: "While you're treating his acne, don't forget the turmoil of adolescence." It was an advertisement for a minor tranquilizer. The idea spread. If young people go through a period of storm and stress in adolescence, medicate them. If women are depressed during menopause, medicate them. If old people talk about the past, put them on some tranquilizers to make them stop. If you get grouchy and irritable, medicate. So we have had ever-increasing use of psychoactive drugs, to the point that today the most commonly prescribed drug in America is Valium, a minor tranquilizer. More people take Valium than any other drug in America, yet Valium did not exist 30 years ago. A major trend, then, has been the increasing licit use of prescribed psychoactive drugs and the use of these drugs for more and more situations that were not considered medical problems in the past. That does not necessarily mean this is wrong. We are only suggesting that things are now being defined more often as medical problems. If a youngster does not behave in school, stimulants or tranquilizers may be prescribed. We do not try to improve the schools. We do not try to correct the problem. We prescribe drugs. Maybe the problem is a lack of discipline. Maybe the problem is an incredibly dull and boring class. But our answer is to prescribe a drug. If a housewife is unhappy with her role as a housewife, the answer is not marital counseling. The answer is not women's liberation. The answer is a tranquilizer. At least that is the impression one gets from reading the medical journals. So we have an increasing tendency to prescribe licit drugs, and now vast numbers of Americans are taking prescribed, psychoactive drugs.

Along with this we have had more over-the-counter drugs put on the market that offer psychoactive effects, including tranquilizers, stimulants, and sleeping pills. We have even seen aspirin marketed as a drug for dealing with tensions and problems. Undoubtedly you have seen different commercials over the last few years that prompt us not to "snap at mother because you've got a headache, take ____" We were given the impression that you could increase tranquility in the family and solve the problems of the generation gap by taking aspirin, sold under another name and at a higher price. So, for the over-the-counter drugs, also, we have seen a trend toward using them to deal with the ordinary problems of human living.

For the most part, we are talking about problems whose solutions do not lie in drug use, yet enormous quantities of drugs are sold for this purpose. There is a continuing tendency to redefine situations in a way that requires drugs for their resolution. Moreover, drugs are beginning to be used to improve situations in which no medical problem exists. As discussed in Chapter 11, we use various drug substances to improve our sex lives. It used to be thought that sex was something you did instinctively, without needing anything extra. Then the idea became popular that you should buy books and read about how to do it and perhaps do some exercises to practice for it. Through recent years we have felt we should take medicine that would make us better sexual performers, so we have come up with a variety of things we take by mouth, inhale, or rub on appropriate parts of our bodies.

Several companies make fortunes selling various things that make certain parts of your body warm or cold or numb or more flavorful. Of course, many people believe that cocaine is a sexual stimulant. Another product that has become popular, initially in the gay community but increasingly among heterosexuals, are drugs known as poppers, which sell under various brand names such as Locker Room and Cat's Meow. These are isoamylnitrite, isobutylnitrite or isobutyl alcohol, which have an immediate stimulant effect on the heart, rapidly increasing heartbeat and also respiration, but to a lesser extent. They also have some cerebral effects as a result of the sudden increase in blood pressure, which may cause some distortion of time perception. This time distortion may make some people think they have longer orgasms. If you come right down to it, if you think an orgasm is longer, that is just as good as if it really was.

This brings us to the 1960s, when things started moving a bit faster. More interest was focused on the psychoactive drugs, particularly marijuana and the psychedelics. We can probably give much of the credit for this to five people: Ringo Starr, George Harrison, Paul McCartney, John Lennon, and Art Linkletter. Al¬though he is not ordinarily linked with the Beatles, Art Linkletter was one of the major publicizers of LSD. The Beatles put out the Sergeant Pepper album, singing about Lucy in the sky with diamonds, singing "I want to turn you on," and singing a great deal of other drug-oriented music; talked to the press about their use of LSD and their use of marijuana, and talked about smoking marijuana in the bathroom at Buckingham Palace before going in to receive the Order of the British Empire. Meanwhile, Art Linkletter was traveling around the country making speeches about the menace of LSD use and how common its use was becoming. He probably convinced many people that the numbers using LSD were large at a time when they probably were not. Many people did not want to feel left out and therefore joined in.

Musical groups such as the Grateful Dead, Jefferson Airplane, and Thirteenth Floor Elevators put together music oriented and centered around the psychedelic drug experience. At about the same time, the American news media created the hippie movement. They found some people in San Francisco in the Haight-Ashbury area, called them flower children, and publicized them widely. Soon youngsters from all over America were running away from home to go to Haight-Ashbury. The basic trend in the drug movement at this point was the use of LSD and marijuana, which got its start most heavily on the West Coast, quickly skipped over to the East Coast, and then diverged toward middle America. The big thrust then was the hippie-flower child movement, LSD and psychedelics, turning on, tuning in, and dropping out. The correct order for that quotation should be drop out, turn on, and tune in; however, the press twisted it, and it stayed that way.

LSD is an exhausting drug. After an LSD trip, people are generally very tired. LSD also produces a post-LSD depression syndrome. The day after taking LSD a person tends to be depressed, sometimes seriously so. Having learned to medicate themselves so readily while looking for "better living through chemistry," people soon discovered that taking amphetamines during depression relieves the symptoms of depression. After taking LSD on Saturday and waking up exhausted and depressed on Sunday, some amphetamine would often be taken to relieve the depression. People then discovered that taking amphetamines on Sunday to get rid of the depression from the LSD on Saturday only delayed the depression until Monday. Amphetamines were then taken also on Monday and then on Tuesday and Wednesday; soon people were taking amphetamines every day. What developed in many of our cities was a major "speed culture" and many "speed freak" addicts. Suddenly the Haight-Ashbury Medical Clinic and other free clinics around the country were no longer treating people on LSD bad trips. They were treating people who were paranoid from amphetamines.

People shortly discovered that the most efficient way to take amphetamines was to inject them. They also discovered something about injecting amphetamines: when you inject an amphetamine, your blood pressure goes up very suddenly, and a sudden change in blood pressure causes strange sensations. These sensations were called rushes. Soon people were injecting the amphetamines for the rush, the sudden rise in blood pressure. (Whenever you hear somebody talk about a rush in relation to drugs, they are talking about a sudden change in blood pressure or about their imagination). A speed culture soon developed that was coupled with the increasing use of drugs by injection. If a person takes many drugs by injection, they begin to develop soreness. After taking many amphetamines, fatigue increases dramatically. In addition, there are many generalized bodily aches and pains. After about 3 days of speeding, the human body is screaming for sleep, but sleep is not possible. Users soon discovered that other drugs will put a person to sleep, and so the speed culture began using depressant drugs also -— speed for three or four days on amphetamines and then take Seconal(R) to sleep. Up and down, like a roller coaster. It is easy to get strung out on amphetamines in terms of a psychological dependence on them or feeling very fatigued and depressed without them, but they are not physically addictive.

Barbiturates can produce a very severe physical dependence in heavy users. Once addicted to them, a person must continue to take them or become severely, perhaps fatally, ill. Many of the people who had been taking the downers to come down off the speed now found themselves taking the downers more and more often. Many found themselves addicted to them, and we thus switched from a speed culture to a downer culture. At the same time, the medical community had decided that amphetamines were not useful for the treatment of overweight, and it started getting harder to get prescriptions for them. The prices for amphetamines as a street drug had gotten very high, whereas Seconal was still fairly inexpensive. So we became more and more concerned with downers, depressant drugs. Since old habits are difficult to break, some people began injecting barbiturates. When depressants are injected, they very likely will cause abscesses. Barbiturates are based on barbituric acid. They are very irritating to skin tissues and, if they happen to be injected outside of the vein into the tissue, a sterile abscess will develop. A sterile abscess is a burned and damaged section of muscle tissue that swells up into a knot and hurts badly, sometimes for a long period of time. Downers, however, also produce a rush in just the opposite direction of amphetamines. The amphetamine rush is a sudden rise in blood pressure. When downers are injected, a sudden drop in blood pressure results that most users think is a better rush than a sudden rise in blood pressure. This is probably because a sudden drop in blood pressure also causes the sensations experienced during an orgasm. The rush associated with injected depressants be¬came very popular even though it was dangerous.

People then started looking around for a drug that would give a downer-type rush, that would not cause sterile abscesses, and that would make the abscesses already there stop hurting. There is such a drug. It is called heroin. It produces a definite downer-type rush that results from a sudden drop in blood pressure, and it does not have the same degree of abscess-producing properties. Septic abscesses from infections under the skin are possible with injected heroin, but it does not produce sterile abscesses to the same extent that the barbiturates do; it is also a highly effective pain reliever. It is most effective with steady, continuous, dull pain, which is the kind of pain caused by an abscess. So we had a great increase in the use of narcotics among the same community of hard-core drug users who had started out as flower children, smoking marijuana and dropping acid. Many of them graduated to the speed culture and eventually to barbiturates and narcotics. This is not meant to imply that there is necessarily a progression from one of these drugs to the others, but the dominant drug culture did go through all these drugs. People entered and left at all stages. Some people started on amphetamines, some on downers, and some on heroin. In studies on the progression from one drug to another in the early 1970s (Duncan. 1975a), it was found that the first illicit drug of abuse for more and more people was heroin. That was the dominant drug in the drug culture at that time and. in order to join the drug culture, people shot heroin. What was once a closely knit drug culture centered in places like Greenwich Village in New York (in San Francisco it was originally the North Side and later Haight-Ashbury; in Houston it was the Montrose area; in Atlanta it was Peachtree Street; and in Washington it was the Dupont Circle area) was now spreading out. In every large city there had usually been one area identified with a group of people who saw themselves as the counterculture, the center for dope dealing, and the center for antiwar activities. As the drug culture spread out and took in more and more people, it became a less homogeneous community. The larger community that it spread out to contained fewer members who were in need of heroin to relieve the pain of abscesses. They had never developed abscesses, and they were not quite ready to accept the idea of sticking needles into their veins. Also, they were getting quite a bit of drug education about the dangers of using needles; much of that education originated from members of the countercultural community who had avoided the needles themselves. Groups like the Do It Now Foundation in Phoenix, which formed to propagandize against the use of drugs by needle (at first amphetamines and later downers) started to campaign within the counterculture.

In this larger community, people were much more into marijuana when another drug that was soon to become the dominant drug began to be noticed. It had been around for a long time, but nobody had given it much attention. It was methaqualone, better known under its various brand names as Quaalude(R), Sopor(R), Somnafac(R), and Mandrax(R).

Methaqualone is a sedative-hypnotic -— a sleeping pill -— and not really that different from the barbiturates. What was important was the fact that people thought it was different. The pharmaceutical manufacturers advertised it as a safer, nonaddicting, and essentially nonabusive substitute for barbiturates. Physicians, believing this to be true, were less cautious about writing prescriptions for Quaalude(R) and its sister drugs than they were about writing prescriptions for the barbiturates. Thus these drugs were relatively easy to acquire.

At the same time, more drug users came to believe some very different things about these drugs, which they called "kways" or "quads." They believed that they gave a high that was far better than other downers. They also believed that methaquaalone was "the love drug" -— an aphrodisiac. As you already read in Chapter 11, this was not true but, as long as people believed it, the popularity of methaqualone was assured.

As word of this phenomenon of methaqualone use reached the larger community, restrictions were placed on the availability of methaqualone. Physicians were no longer so casual about writing prescriptions for Sopor(R) or Quaalude(R). Methaqualone became as hard to get as the barbiturates. Diazepam -- "Prince Valium" -- reigned as the only prescription downer that almost anyone could acquire. People also began rediscovering the psychedelic drugs. LSD had been around all along and, despite rumors of its demise, it was still available, in more and more potent doses. People in several parts of the country discovered that there were psychedelics growing in the pastures and forests of America -— the psilocybin mush¬room and its psychedelic relatives. We have seen more use of psychedelic mushrooms in areas of America where they grow wild.

Another drug that began to appear frequently was cocaine. It too had been around for a long time, but it was an expensive drug. Only the wealthy could afford it and, in most people's minds, it was associated with the glamorous members of the movie and music business. Thanks to the Nixon administration's Operation Intercept, smuggling operations from Mexico and other countries have been greatly improved. Connoisseurs of marijuana began insisting on Columbian marijuana, Panamanian marijuana, and so on; most of it really came from Mexico or Kansas, but some did come from Columbia or Panama. When smugglers began bringing in marijuana from Columbia or Venezuela, they discovered that cocaine sold at a higher price and weighed less, making it a more practical drug to smuggle. As a result, more cocaine began coming into the country at cheaper prices and was therefore available to people other than the very rich.

One of the major new drugs, particularly on the West Coast, is known as "Green" or "Mauve" or occasionally "special LA coke." "Green" is, in fact, a drug known as ketamine hydrochloride. Ketamine is an anesthetic drug, a local anesthetic, as is cocaine. Its effects are very similar to those of cocaine. The underground literature generally describes this as an absolutely safe drug that produces cocaine-type stimulation plus laughter (R. Duncan, 1976). It apparently produces giddy laughter like that caused by nitrous oxide -— the famous "laughing gas" —- which also has been becoming more popular, especially on the West Coast. "Green," in fact, is not as safe as the underground literature suggests. Bad trips, flashbacks, and spontaneous occurrence of pain are all frequently reported in the literature on ketamine (Siegel and Jarvik, 1975; Perel and Davidson, 1976).

LOOKING FORWARD

We now offer seven predictions about trends in drug use. Over the next decade the following trends can be expected.

1) Marijuana use will continue to increase and to gain social and legal accepta¬bility.

2) Cocaine use will also continue to increase.

3) PCP or "angel dust" will remain with us, but selling it as THC will become a thing of the past.

4) Psilocybin mushrooms will replace LSD as the predominant psychedelic drug as home culturing becomes increasingly popular.

5) Commercial herbal-based preparations will be more popular as legal substi¬tutes for illicit drugs; some will really duplicate the effects of popular illicit drugs, and others will be deceptions.

6) New drugs will, of course, emerge from the laboratory and gain at least fleeting popularity.

7) Intranasal administration of drugs—"snorting"—will become more accepted and popular.

DRUG MYTHS

A variety of myths grew among drug users about drugs over this time. Probably the biggest of these myths and one that was very much ascribed to by most of the people in the countercultural movement was that organic drugs are better for you than synthetic drugs. They are, of course, misusing the term organic in the same way that it is misused when you hear somebody talk about organic gardening or organic vegetables. All vegetables are organic, and the greater part of the psychoactive drugs are organic. Organic simply means a chemical structure that contains carbon atoms. What is usually meant by organic drugs is natural drugs, straight out of a vegetable source without being processed in any way that chemically altered them. The overwhelming viewpoint was that it was much better for you to eat plant substances or smoke plant substances than to eat or smoke things produced in laboratories. Capsules containing what was said to be organic mescaline sold at higher prices than capsules containing what was said to be synthetic mescaline, despite the fact that both contained LSD in almost every case.

In fact, as a general rule, it is accurate to say that "organic" drug substances are less safe than synthetic drug substances, since a natural substance is certainly less pure and generally less predictable. If someone wants to experience mescaline they would certainly be doing something much safer by taking synthetic mescaline than by eating peyote cactus, which contains psychoactive substances other than mescaline.

One of the reasons for this myth relates to what major industries have done to the term synthetic. The term synthetic in its proper usage means an exact duplicate, but we have been fooled by major industries with things such as "synthetic rubber" and other synthetic products. When an industry makes synthetic rubber to put in your tires, they do not mean rubber; they mean an artificial substitute for rubber.

Another major myth was that there are generally two types of psychoactive drugs: head drugs and body drugs. Some drugs were said to act mainly on your mind and others mainly on your body. Some marijuana was said to give a head trip and some to give a body trip. Psilocybin was said to give a head trip and mescaline to give a body trip, and the like. This, of course, was related to the myth of mellow psychedelics versus electric psychedelics, of good grass versus bad grass, of bad trips being caused by bad LSD and good trips being caused by good LSD. In fact, all psychoactive drugs affect both the mind and the body. The nature of the effects a person will experience from any drug depends on the drug itself, the setting in which the drug is taken, and the mental and physical set of the user. Drug effects result from an interaction between the drug and the whole person.

FROM HERE TO ETERNITY

Much time has been spent speculating on the major consequences of drug use, misuse, and abuse. There are many theories about the medical, psychiatric, and societal consequences. Kaiser (Kaiser and Gold, 1974) has done some work in the area of social consequences of the increased use of drugs that allows us to speculate about the future. This section is devoted to those theories.

Our perception of reality is a complex phenomenon to explain. How do we perceive reality? Is there one reality or many? Casteneda (1968) talks of consensus reality. In any case, Kaiser hypothesizes that we perceive reality based on three metaphors (ways of knowing): cause and effect, time, and space. Perhaps the best example of how these three metaphors are used to perceive reality is based on an experience that almost everyone has had. Most of us learn this on early camping expeditions; if you saw a bolt of lightning, you knew that thunder would follow— cause and effect—and that if you counted the number of seconds between the bolt of lightning and the thunder you would be able to tell how far away the lightning struck. If there were 5 seconds between the two, the lightning struck 1 mile away. This is how we perceive everything around us—cause and effect, over time, and through space. What we call reality is based on our ability to perceive it utilizing these three metaphors.

One group of people, predominantly sociologists, believe in a theory called the self-fulfilling prophesy, which essentially means that if something is perceived to be real and is acted on as being real, the consequences become real. At one time the dollar bill had a gold standard. Everyone knew that it was backed by gold, so people accepted it as legal tender. Then the gold standard was changed to a silver standard, and we still felt that the dollar bill was backed by something. Now the dollar bill is not backed by anything. There is not enough gold in Fort Knox to back all the money that we have in circulation. There is not enough silver anywhere to back all the money that we have in circulation. But all of us, or at least enough of us, agree that a dollar bill is worth something, and we act on it as being worth something, we accept it as legal tender, and it therefore becomes worth something.

The same thing happens with social institutions. Social institutions grow out of what the majority of people agree is reality. At the turn of the century, many people in this country thought that black people were lazy. An employer who believed that black people were lazy would not hire them. If enough people would not hire blacks, many would remain unemployed. People who cannot find work soon lose their motivation to try and, by default, act lazy. What happened was that it was believed that certain people are lazy, that was acted on as being true, and the consequences became real. This is how our society is structured.

By consensus, if enough people perceive something to be true, enough people act on it as being real, and the consequences become real. Every institution that we have today is based on that relationship. When enough people agree that something is necessary and that something can work and they act on it as such, social institu¬tions are shaped.

Let us consider cause and effect, time, and space. These are the three metaphors by which we perceive things to be real. By definition these are the three things on which all psychoactive drugs have an effect. Since all psychoactive drugs affect how we think and feel, all psychoactive drugs have an affect on how we perceive what is going on around us. So what are going to be the major conse¬quences of the increasing use of psychoactive drugs? Not medical, not psychological, not legal, but the greatest affect that the increase in use of psychoactive drugs has is on our social institutions and the way we live. Think about the changes that have occurred over the last 15 years in our society, dramatic changes, things that we do not notice on a day-to-day basis. But someone who has been out of the country for 10 years and comes back does not recognize this as the same place. The same thing happens when you buy a puppy or a kitten. You do not notice it growing from day to day, but leave it for 6 months or 1 year and come back and you will not recognize it as the same animal. This is the major affect that psychoactive drugs have today. Most people do not seem to have too many medical, legal, or psychological problems, but the increasing use of psychoactive drugs, along with increasing improvements in technology, have changed the way we live.

What is the end product of this process? When enough people are using psychoactive drugs to the point where the metaphors by which we perceive reality are questioned, the only end product of consequence is social change, not medical, psychological, or legal problems.

What the future will hold cannot be speculated on here. However, it is clear that to some extent, the future will be molded by drug-affected consciousness.

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